Self-Care for Eye and Ear Disorders

Self-Treatable Ophthalmic Disorders

1. Dry Eye Disease

2. Diagnosed Corneal Edema

3. Loose Foreign Substances in the Eye

4. Minor Eye Irritation

5. Chemical Burn

6. Artificial Eyes

7. Contact Dermatitis of the Eyelid

Exclusions for Self-Care

Eye Surface Disorders:

• Eye pain

• Blurred vision (not associated with use of ointments)

• Sensitivity to light

• History of contact wear

• Blunt trauma to the eye

• Chemical exposure affecting eye

• Eye exposure to heat, excluding sun exposure

• Symptoms persisting >72 hour

Eyelid Disorders:

• Signs and symptoms of infection of eyelid

• Blunt trauma to the eye

• Exposure of eye to chemicals

• Head lice

• Macular degeneration

• Hordeolum, chalazion, blepharitis

dry eye disease

tears aren't able to provide adequate moisture to the eyes

● Aging

● Drugs

● Allergens/environment

● Lid/corneal defects

● Sjogren syndrome

● Bell's palsy

● Thyroid disorder

● Rheumatoid arthritis

What are the potential causes of dry eye disease?

● Anticholinergics:

○ Antidepressants

○ Antihistamines

● Decongestants

● Diuretics

● Beta blockers

What are the drugs that can cause dry eye disease?

clinical presentation of dry eye disease

● White or mildly red eye

● Sandy, gritty feeling or sensation of something in the eye

● Excessive tearing

● Can result in damage to corneal surface

● Alleviate and control dryness of the ocular surface

● Relieve symptoms of irritation

● Prevent possible tissue/corneal damage

What are the goal of tx in dry eye disease?

mild

You can only self treat ________ dry eye disease not moderately severe, severe, or treatment resistant.

non-pharm therapy for dry eye disease

• Warm compresses

• Elimination of offending agents

• Environmental modifications:

○ Use humidifiers

○ Avoid dry, dusty places

○ Avoid air vents

○ Avoid prolonged computer screens

pharm therapy for dry eye disease

-ocular lubricants (artificial tears and unmedicated ointments or gels)

-omega-3 oils or flaxseed oil supplements

MOA of Artificial tears

stabilize tear film, protect cornea and conjunctiva, reduce tear evaporation, enhance wound healing and lubrication of ocular surface

Artificial Tears

-Consist of different "active ingredients" and vehicles

○ Glycerin, carboxymethylcellulose (CMC), polyvinyl alcohol (PVA), povidone, etc.

-Can also contain preservatives

less

Preservatives in artificial tears have _______ infection risk

more

Preservatives in artificial tears can have ________ irritation risk

immediately after being opened/used

When should preservative-free products be discarded?

admin of Artificial Tears

-Typically 1-2 drops 2-4 times a day (up to hourly w/ severe)

-May be continued indefinitely in some cases

-Side effects: blurred vision, eye irritation

72 hrs

If symptoms do not subside after ________ of treatment for dry eye disease, the patient should be encouraged to seek further assessment from an eye care specialist.

enhanced retention time in the eye

What is the advantage to using non-medicated ointments in dry eye disease?

-white petrolatum

-mineral oil

-lanolin

What are the primary ingredients for non-medicated ointments for dry eye disease?

admin of non-medicated ointments for dry eye disease

-Typically twice daily (up to "every few hours" w/ severe)

-Side effects: blurred vision (ointment > gel), eye irritation

-Many patients prefer bedtime application due to blurry vision

instill the drops first at least 10 mins before the ointment

If a pt is using both a drop and ointment in which order should they administer them?

long

You should use preservative free for ______ term use but more expensive and easier to contaminate.

corneal edema

-Accumulation of fluid in the cornea

-Can be caused by surgical damage, overwear of contacts, genetics

an eye care specialist must dx the patients with this disorder

What must happen in corneal edema before self-treatment is attempted?

halos or starbursts around lights (can be caused by overwear of contact lenses or surgical damage)

What are the hallmark symptoms for corneal edema?

draw fluid from the cornea

What is the tx goal with corneal edema?

hyperosmotic agents

What is the tx approach for corneal edema?

sodium chloride

-Only OTC available in both solution (2% or 5%) and ointment (5%) for corneal edema

○ 1st line = 2% solution, 1-2 drops 4 times per day

-Preferred for long-term therapy due to less AE than 5%

○ Most effective = 5% ointment

-More AE of stinging and burning

NO

Can patients use homemade saline solutions for corneal edema?

loose foreign substance

-If exposure to the substance causes only minor irritation, with no abrasion of the eye surface, self-treatment is appropriate

-Eyelash, lint, dust, etc.

-Flush the eye with sterile saline or eyewash irrigant

○ If not near an eyewash - sink faucet or garden hose to produce

copious amounts of water is appropriate

refer

If a pt has wood, metal, eye pain, or an open wound you need to ________ them

OTC

All eye irrigants are available ______ but should only be for short-term use

eye care specialist

If the patient experiences unremitting eye pain, changes in vision, continued redness, or irritation of the eye, or if the ocular condition persists or worsens, in loose foreign substances then evaluation by an _____________ is strongly recommended.

(nonallergic) minor eye irritation

can be caused by contact lens wear, or exposure of the eye to wind, sun (e.g., during snow skiing without protective eye goggles), smog, or chemical fumes (swimming pool chlorine)

-tx similar to dry eye disease

-or zinc sulfate (mild astringent) 1-2 drops up to 4x/day

-many combo products available

What is the tx for minor eye irritation?

refer

If a pt has snow blindness, UV burns, or pain you need to ______ them.

chemical burn

-range in degree from mild to severe, depending on the inciting

agent and/or exposure time.

-REFER: Irrigation with sterile saline or tap water (if nothing else available) and CONTINUE until eye specialist is seen!

artificial eyes

-Routine hygiene (mild soap and water) is important to clear dried mucus or fluid secretions from the surfaces

-Sterile, isotonic buffered solution containing:

1. Tyloxapol 0.25%: surfactant

2. BAK 0..02%: wetting agent

1-2 drops 3-4x/day WITH the artificial eye in place

*can also be used as a cleaner if eye is removed

contact dermatitis of the eyelid

Can be a reaction to either an allergen or an irritant (both eyes involved suggests allergen)

1. Remove offending agent

2. Cold compresses 3-4x/day

3. Oral antihistamines if needed

What is the tx for contact dermatitis of the eyelid?

ocular lubricants

Tx of choice for dry eyes:

issues unresolved > 72 hrs

When do you refer for dry eyes?

hyperosmotic agents (sodium chloride)

Tx of choice for corneal edema:

issues unresolved > 72 hrs

When do you refer for corneal edema?

irrigant solutions

Tx of choice for loose foreign substances:

Wood, metal, eye pain, or open wound; or Issues unresolved >72hours

When should you refer for loose foreign substances?

artificial tears, zinc sulfate

What is the tx of choice for minor eye irritation?

Snow blindness, UV burns, pain or > 72 hours

When should you refer for minor ear irritation?

irrigate then REFER

Tx of choice for chemical burns:

Routine hygiene + Buffer solution

(Tyloxapol + BAK)

Tx of choice for artificial eyes:

none

When should you refer for artificial eyes?

Remove offending agent

Cold compresses + Oral AH

Tx of choice for contact dermatitis:

Issues unresolved >72 hours; any eyelid disorder exclusions

When should you refer with contact dermatitis?

Ophthalmic Drop Administration

1) Inspect the medication (for tampering, accuracy, expiration)

2) Wash hands with soap/water and dry them

3) Remove contact lens (if worn)

4) Remove cap/open container

5) Tilt the head back

6) Hold the medication bottle with dominant (writing) hand

7) Avoid touching tip of the bottle to eye or anything else to prevent contamination

8) Pull lower eyelid down with non-dominant hand to form a pocket/pouch

9) Look upward

10) Squeeze bottle to instill proper number of drops into eyelid pocket

11) Release lower eyelid

12) Close eyes, apply gentle pressure to inner corner of eye with index finger

13) Repeat in opposite eye (if directed)

14) If 2nd product is to be used in same eye, wait 5+ minutes for drop, 10+ minutes for ointments

15) Re-cap/close the container

16) Use a clean tissue to wipe away excess medication from eye/face

17) Wash hands after administration

18) Wait 10 - 15 minutes before putting contact lens back in

Ophthalmic Ointment Administration

1) Inspect the medication (for tampering, accuracy, expiration)

2) Wash hands with soap/water and dry them

3) Remove contacts, if applicable

4) Remove cap

5) Tilt head backward

6) Hold tube with dominant hand

7) Pull down lower eyelid with non-dominant had to create a pocket

8) Look upward

9) Apply a thin, 1 inch line of the ointment to the pocket

10) Twist wrist to break strip of ointment

11) Do not let applicator touch eyelid

12) Release eyelid and close eyes for 1-2 minutes

13) Clean tip with a clean tissue; May also blot excessive ointment

from around the eye

14) Replace cap

15) Explain that vision may be blurry temporarily

16) Wash hands after administration

Self-Treatable Ear Disorders

-Excessive/Impacted Cerumen

-Water-clogged Ears

Differential Diagnosis

• Ruptured tympanic membrane

• External otitis (swimmer's ear)

• Otitis media

• Foreign object in ear

• Trauma to ear

• Tinnitus

Exclusions for Self-Care for Ear Disorders

• Signs of Infection

• Pain with ear discharge

• Dizziness (*water-clogged ears only)

• Bleeding or signs of trauma

• Ruptured tympanic membrane

• Ear surgery in the prior 6 weeks

• Tympanostomy tubes present

• <12 years of age (*impacted cerumen only)

• Incapable of following proper instructions

• Hypersensitivity to recommended agents

• Worsening of symptoms after attempted self-treatment

Excessive/Impacted Cerumen

"lodged, wedged, or firmly packed" cerumen in the EAC

earwax

naturally occurring, defense mechanism

Causes of excessive/impacted cerumen

● Use of cotton-tipped applicators

● Narrow/misshapen EAC

● Excessive hair growth

● Overactive ceruminous glands

● Age

● Genetic tendency

● Irritation from foreign objects

○ Hearings aids, ear plugs, airpods

s/s of excessive/impacted cerumen

• Fullness/pressure in the ears

• Dull pain/itching

• Gradual hearing loss

• Tinnitus

• Dizziness or vertigo

• Cough

• Hearing aid

malfunction/feedback

• Potential impaired cognition (especially in elderly)

-Soften and remove cerumen safely & properly

-Eliminate temporary hearing loss (if present)

-Prevent potential adverse events

What are the goals of tx with excessive/impacted cerumen?

not required

The updated clinical practice guidelines state that if the presence of excessive cerumen is asymptomatic, active management is _____________, and manual removal of cerumen is optional rather than recommended.

non-pharm therapy for excessive/impacted cerumen

-use a wet washcloth over finger as part of daily hygiene to prevent build up

-manual earwax removal

-warm water irrigation with bulb syringe

-NEVER use ear wax candles

manual earwax removal

-Should only occur when it has migrated to the outermost portion of EAC

-Ear-cleaning tool (or curette) should be used (not Q-tips)

warm water irrigation with bulb syringe

-use STERILE water

-self use of oral jet irrigator NOT recommended

Carbamide Peroxide

What is the pharm tx for excessive/impacted cerumen?

Carbamide Peroxide 6.5% in anhydrous glycerin MOA

-effervescence and urea break down cerumen

■ Weak antibacterial effect

Carbamide Peroxide 6.5% in anhydrous glycerin

-FDA approved for ages 12 and older

-Administration:

■ 5-10 drops into the affected ear(s)

■ Wait 15 minutes, then irrigate

■ Do all this twice daily for up to 4 days

-Adverse effects:

■ Pain, rash, discharge

■ Irritation, tenderness, redness

■ Dizziness

water-clogged ears

-water trapped behind the typanic membrane (ear drum)

-NOT swimmer's ear

causes of water-clogged ears

-Unique ear shapes

-Excessive cerumen

-Hot, humid climates

-Other excessive moisture

○ Sweating, swimming, bathing

s/s of water-clogged ears

-Wetness/Fullness feeling in the ear

-Gradual hearing loss

-Water presence → Tissue breakdown → itching, pain, inflammation, or infection

-remove water safety and properly

-prevent recurrences in susceptible persons

What are the goals of tx with water-clogged ears?

make sure the pt does not have ruptured tympanic membrane or rympanostomy tubes

Before you recommend tx for water-clogged ears you must ensure the pt does not have what?

non-pharm tx for water-clogged ears

-Prevent exposure and accumulation of moisture within the EAC

○ Earplugs or bathing cap when swimming

-Remove any trapped water

○ Water-absorbing ear plugs (i.e. ClearEars)

■ Placed within canal for 5-10 minutes, then removed and discarded

■ Adult supervision is required for use in children younger than 11 years

-Blow dryer

■ On LOW heat and speed

-Gravity drainage

■ Pull the ear lobe gently while tilting the head

downward, straightening EAC

Isopropyl alcohol 95% in anhydrous glycerin 5%

What is the pharmacological therapy for water-clogged ears?

Isopropyl alcohol 95% in anhydrous glycerin 5%

-Ear-drying aid & skin disinfectant

○ Glycerin component helps to prevent over-drying of tissue in the canal

-FDA-approved with no minimum age

-Administration:

○ Instill 4-5 drops in the affected ear

○ Allow the solution to remain for 1-2 minutes

-Counseling:

○ Keep away from fire (flammable)

○ Avoid contact with eyes

Carbamide peroxide 6.5%

Tx of choice for excessive/impacted cerumen:

isopropyl alcohol 95% in anhydrous glycerin 5%

Tx of choice for water-clogged ears:

• Age < 12 (cerumen only)

• Ruptured tympanic membrane

• Tympanostomy tubes

• Signs of infection or trauma

• Bleeding or dizziness

• If symptoms persist after attempted self-treatment

When do you need to refer for excessive/impacted cerumen or water-clogged ears?

Otic Drop Administration

1) Inspect the medication (for tampering, accuracy, expiration)

2) Wash hands with soap/water and dry them

3) Wash and dry outer ear (without getting water into ear canal)

4) Warm drops to body temperature by holding in the palm of your hand

5) Shake the product (if needed; e.g., suspension)

6) Tilt the head (lie on side) with affected ear facing upward

7) Open the medication bottle/container

8) Place the dropper tip near ear opening without touching the dropper tip to the ear

9) Pull the ear to properly open the ear the canal (adult: backward and up; child <3: backward and down)

10) Instill the proper number of drops

11) Press the skin flap (tragus) over the ear opening several times to remove air bubbles and help the drops fall into the ear canal

12) Maintain head tilt with affected ear facing up for a few minutes (or to insert a cotton ball/plug into ear)

13) Repeat administration steps in the opposite ear (if needed)

14) Wipe excess medication off outer ear

15) Wash hands after administration

backward and up

For adults how do you pull the ear to properly to open the ear canal?

backward and down

For children < 3 yo how do you pulls the ear to properly to open the ear canal?